Point-of-Use Water Point-of-Use Water TreatmentTreatment

&&LifeStraw®LifeStraw®

Christian Connections for International Health (CCIH) Christian Connections for International Health (CCIH) 24 May 200824 May 2008

AttributionAttribution

Tom Clasen, London School of Tom Clasen, London School of Hygiene and Tropical Medicine Hygiene and Tropical Medicine (LSHTM), presentation (LSHTM), presentation Washington DC, February 2008Washington DC, February 2008

University of North Carolina (M. University of North Carolina (M. Sobsey, J. Brown)Sobsey, J. Brown)

LSHTM (S. Cairncross, V. LSHTM (S. Cairncross, V. Curtis, I. Roberts, T. Rabie, L. Curtis, I. Roberts, T. Rabie, L. Smith, W. Schmidt, S. Thomas)Smith, W. Schmidt, S. Thomas)

WHOWHO

3963

2777

1798 15661271

611

0500

10001500200025003000350040004500

De

ath

s (

00

0s

)Leading Causes of Deaths from Leading Causes of Deaths from

Infectious DiseasesInfectious Diseases2004 World Health Report

Childhood Mortality by CauseChildhood Mortality by Cause

Black RE, Morris SS & Bryce J (2003). Where and why are 10 million children dying every year? Lancet 361:2226-34.

1990s: Reduction in Diarrhea from Improvements 1990s: Reduction in Diarrhea from Improvements in Water Qualityin Water Quality

Expected reduction in diarrheal disease morbidity from Expected reduction in diarrheal disease morbidity from improvements in one or more components of water and improvements in one or more components of water and

sanitation (Esrey, 1991)sanitation (Esrey, 1991)

   All StudiesAll Studies Rigorous StudiesRigorous Studies

   No. StudiesNo. Studies ReductionReduction No. StudiesNo. Studies Reduction Reduction

Water and Water and SanitationSanitation 77 20%20% 22 30%30%

SanitationSanitation 1111 22%22% 55 36%36%

Water Quality and Water Quality and QuantityQuantity 2222 16%16% 22 17%17%

Water QualityWater Quality 77 17%17% 44 15%15%

Water QuantityWater Quantity 77 27%27% 55 20%20%

HygieneHygiene 66 33%33% 66 33%33%

              

Interventions at SourceInterventions at Source

Effectiveness Data: Cochrane Review

Clasen T, Roberts I, Rabie T, Clasen T, Roberts I, Rabie T, Schmidt W, Cairncross S. Schmidt W, Cairncross S. Interventions to improve Interventions to improve water quality for preventing water quality for preventing diarrhoea (A Cochrane diarrhoea (A Cochrane Review). In: The Cochrane Review). In: The Cochrane Library, Issue 3, 2006. Library, Issue 3, 2006.

Summary of Effectiveness—Under 5sSummary of Effectiveness—Under 5sIntervention Type Intervention Type

(no. trials)(no. trials)

EffectEffect

(random)(random)

% % ΔΔ

(1-RR)(1-RR)

95% CI of 95% CI of EstimateEstimate

Source (4)Source (4) 0.850.85 15%15% 0.71 to 1.020.71 to 1.02

Household (25)Household (25) 0.560.56 44%44% 0.39 to 0.810.39 to 0.81

Filtration (5)Filtration (5) 0.360.36 64%64% 0.24 to 0.530.24 to 0.53

Chlorination (12)Chlorination (12) 0.760.76 24%24% 0.67 to 0.860.67 to 0.86

Solar Disinfection (0)Solar Disinfection (0) nana nana nana

Flocc/Disinfection (7)Flocc/Disinfection (7) 0.520.52 48%48% 0.20 to 1.370.20 to 1.37

Flocc/Disinf (6)(Flocc/Disinf (6)(ex Doocy*)ex Doocy*) 0.710.71 29%29% 0.61 to 0.840.61 to 0.84

Impr. Storage (1)Impr. Storage (1) 0.690.69 31%31% 0.47 to 0.810.47 to 0.81

Interventions at the HouseholdInterventions at the Household

Continuing Challenges in Point-of-Use Continuing Challenges in Point-of-Use

No successful large-scale modelsNo successful large-scale models Little evidence that purely commercial strategies Little evidence that purely commercial strategies

reach the most vulnerable populationsreach the most vulnerable populations Questions about whether any HWTS product or Questions about whether any HWTS product or

implementation strategy has achieved consistent, implementation strategy has achieved consistent, correct and sustained use among the most correct and sustained use among the most vulnerable populationsvulnerable populations

Little success in attracting significant donor funding Little success in attracting significant donor funding (compared, e.g., to HIV/AIDS, TB, malaria)(compared, e.g., to HIV/AIDS, TB, malaria)

Scaling Up: 2005-2007Scaling Up: 2005-2007NUMBER OF HWTS USERS BY YEAR

0

5000

10000

15000

20000

25000

2005 2006 2007

Year

Num

ber o

f Use

rs (0

00s)

Aquatabs

PUR

Sodis

Biosand Filters

CWP-Cambodia

SWS-PSI

100% Coverage of 1.1B without access 100% Coverage of 1.1B without access to improved water suppliesto improved water supplies

NUMBER OF HWTS USERS BY YEAR

0

200000

400000

600000

800000

1000000

2005 2006 2007

Year

Num

ber o

f Use

rs (0

00s)

Aquatabs

PUR

Sodis

Biosand Filters

CWP-Cambodia

SWS-PSI

Coverage G

ap

Different Needs / Different DriversDifferent Needs / Different Drivers

TIMETIME

Development of Development of Commercial Commercial

MarketMarket

Subsidy / Time-Subsidy / Time-limited Interventionlimited Intervention

EquityEquity

Different Needs / Different DriversDifferent Needs / Different Drivers

TIMETIME

SOUTH SUDAN

CONGO (DRC)

PNG

ZAMBIA

CAMBODIA

NIGERIA

GHANA

SENEGAL

INDIA

CHINA

MEXICO

BRAZIL

1 2 3 4

LifeStraw FamilyLifeStraw Family Highly effective against all categories of Highly effective against all categories of

microbial pathogensmicrobial pathogens High output (150ml/min)High output (150ml/min) High capacity (>18,000 L)High capacity (>18,000 L) Operates in high and variable turbidity (15 NTU)Operates in high and variable turbidity (15 NTU) Low cost Low cost Easy to deploy, learn, use, maintainEasy to deploy, learn, use, maintain Portable, robustPortable, robust Improves water aestheticsImproves water aesthetics No chemicalsNo chemicals No replacement partsNo replacement parts Protects against recontaminationProtects against recontamination

Lab TestingLab Testing

LifeStraw Family: Congo LifeStraw Family: Congo